MEDICARE: INLAND DIAGNOSTIC IMAGING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center		CA

General Provider Information

NPI Number	:	1003325283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INLAND DIAGNOSTIC IMAGING

Provider Business Mailing Address
First Line	:	9373 HAVEN AVE
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-5341
Country	:	US
Telephone Number	:	909-476-4474
Fax Number	:	909-476-7363

Provider Business Practice Location Address
First Line	:	9373 HAVEN AVE
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-5341
Country	:	US
Telephone Number	:	909-476-4474
Fax Number	:	909-476-7363

Authorized Official
Title or Position	:	OWNER
Name	:	FADY ELALAM
Credential	:
Telephone Number	:	909-699-0000

Provider Enumeration Date	:	09/20/2017
Last Update Date	:	07/21/2022

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Directions to “INLAND DIAGNOSTIC IMAGING ” Practice Location

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